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Robotic Coronary Bypass: Coronary Artery Stabilization Without The Endowrist Stabilizer For A Second Arterial Graft
Ghulam Murtaza, MD1, Korey Zellner
1, Rebecca Wachowiak, PA-C
1, Husam H. Balkhy, MD
2.
1SSM Health, Madison, WI, USA,
2University of Chicago, Chicago, IL, USA.
BACKGROUND:
Multi-arterial grafting offers superior long-term outcomes in coronary artery bypass grafting (CABG) due to the durability of arterial grafts. However, sternal wound infection risk limits the use of bilateral internal thoracic arteries (BITA), especially in diabetic and obese patients. Robotic totally endoscopic coronary artery bypass (TECAB) offers a sternal-sparing alternative with excellent outcomes. The absence of the EndoWrist Stabilizer™ on the Da Vinci Xi system has introduced challenges in achieving coronary artery stabilization for robotic TECAB, particularly for multi-arterial grafting.METHODS:
Two cases were reviewed to demonstrate the feasibility of performing robotic TECAB using a table-mounted stabilizer (Medtronic Octopus Nuvo) as an alternative to the discontinued EndoWrist Stabilizer™. Surgical technique included a novel port configuration, warm humidified CO₂ insufflation, and precise stabilization facilitated by the Octopus Nuvo stabilizer. Intraoperative graft patency was assessed using transit time flow measurement.RESULTS:
Case 1: A 68-year-old male with multivessel coronary artery disease underwent BITA grafting, with the right internal thoracic artery (RITA) anastomosed to the obtuse marginal branch and the left internal thoracic artery (LITA) to the left anterior descending artery (LAD). Case 2: A 63-year-old male with two-vessel disease underwent LITA sequential grafting to the LAD and a diagonal branch. Using the Octopus Nuvo stabilizer, precise coronary stabilization and grafting were achieved. Both patients recovered without major complications and were discharged on postoperative day 3 and 2, respectively.CONCLUSIONS:
These cases demonstrate the feasibility of robotic TECAB with multi-arterial grafting using a table-mounted stabilizer. This approach enables surgeons to perform entirely endoscopic, off-pump coronary bypass surgery, addressing the limitations of the current robotic system. The findings underscore the potential of innovative techniques to expand the scope of robotic CABG while highlighting the need for further advancements in robotic stabilization technology to optimize minimally invasive cardiac surgery.
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